Treating for Cure or Palliation: Difficult Decisions for Older Adults with Lymphoma
|
|
- Beverly Walker
- 5 years ago
- Views:
Transcription
1 Treating Frail Adults With Common Malignancies: Best Evidence to Personalize Therapy Treating for Cure or Palliation: Difficult Decisions for Older Adults with Lymphoma Raul Cordoba, MD, PhD Lymphoma Unit Fundacion Jimenez Diaz University Hospital, Madrid, RAUL CORDOBA, MD, 1
2 Disclosures Speaker honoraria: BMS RAUL CORDOBA, MD, 2
3 Agenda Aging and lymphoma Immunosenescence and antitumoral immune response Evasion mechanisms of immune response in lymphoma Tailoring therapy in older patients with lymphoma Efficacy and safety of immunotherapy in older patients with lymphoma RAUL CORDOBA, MD, 3
4 Agenda Aging and lymphoma Immunosenescence and antitumoral immune response Evasion mechanisms of immune response in lymphoma Tailoring therapy in older patients with lymphoma Efficacy and safety of immunotherapy in older patients with lymphoma RAUL CORDOBA, MD, 4
5 Higher incidence of NHL in older people SEER , All Races, Both Sexes RAUL CORDOBA, MD, 5
6 Improvement of outcome in older DLBCL patients Treatment and relative survival in very elderly patients with DLBCL in The Netherlands: a population-based study, 1989 to 2015 Dinmohamed AG et al. Blood Advances 2017;1: RAUL CORDOBA, MD, 6
7 Specific Entities of Lymphoma in the Elderly Age-Related Molecular Specificities in DLBCL 1 - Median age of occurrence of GC-DLBCL is 8 years younger than ABC-DLBCL 2 - More unfavorable genetic features: higher BCL2 expression, high genomic complexity 3 EBV DLBCL of the Elderly - DLBCL of the elderly will be replaced by EBV+ DLBCL, NOS 4 - New entity EBV+ mucocutaneous ulcer, associated with age-related immunosenescence 4 1. Sarkozy C et al. Curr Oncol Rep. 2015;17(7):32 2. Mareschal S et al. Haematologica. 2011;96(12): Klapper W et al. Blood. 2012;119: Swerdlow SH et al. Blood. 2016;127(20): RAUL CORDOBA, MD, 7
8 Agenda Aging and lymphoma Immunosenescence and antitumoral immune response Evasion mechanisms of immune response in lymphoma Tailoring therapy in older patients with lymphoma Efficacy and safety of immunotherapy in older patients with lymphoma RAUL CORDOBA, MD, 8
9 Immunosenescence A) Host related Age 1 Chronic inflammation. Example: CMV 2 B) Disease related Impairment in antigen presentation. Example: PMBCL Immunosupressive phenotype. Example: HL, PMBCL, PCNSL, PTL T-cell exhaustion. Example CLL Nikolich-Zugish J. Nature Immunology 2018; 19: Caruso C et al. Immunity & Ageing 2009, 6:10 3. Gassner FJ et al. Br J Haematol 2015;170(4): Jimenez I et al. Blood 2017; 130:1713 RAUL CORDOBA, MD, 10
10 The cancer-immunity cycle Chen D, Mellman I. Immunity 2013;39(1):1-10 RAUL CORDOBA, MD, 11
11 Impairment of the cancer-immunity cycle with age Elias R et al. J Geriatr Oncol. 2017;8(3): RAUL CORDOBA, MD, 12
12 How to assess immunosenescence? Mahnke YD et al. Eur J Immunol 2013;43(11): RAUL CORDOBA, MD, 13
13 Agenda Aging and lymphoma Immunosenescence and antitumoral immune response Evasion mechanisms of immune response in lymphoma Tailoring therapy in older patients with lymphoma Efficacy and safety of immunotherapy in older patients with lymphoma RAUL CORDOBA, MD, 13
14 Evasion mechanisms of immune response in lymphoma Alterations in 9p24.1 PD-L1/PD-L2 1 Inactivating mutations/deletions of β2m (MHC class I) 2 Inactivating mutations of CIITA (MHC class II) 3 1. Green MR et al Blood. 2010;116(17): Roemer MGM et al. Cancer Immunol Res 2016; 4(11): Roberts RA et al. Blood. 2006;108(1):311-8 RAUL CORDOBA, MD, 17
15 Overexpresion of PD-L1 in lymphoma Alterations in copy number - Frequent in HL 1, PMBCL 1, PCNSL 2, PTL 2 Chromosomal traslocations -Less frequent, but recurrent in HL 3, PMBCL 4, PCNSL 2 y PTL 2 Viral infections: EBV+ 5,6 - HL, PTLD, DLBCL, PBL 1. Green MR et al Blood. 2010;116(17): Chapuy B et al. Blood. 2016;127(7): Roemer MGM et al. J Clin Oncol 2016;34(23): Twa DD et al. Blood. 2014;123(13): Green MR et al. Clin Cancer Res. 2012;18(6): Bi XW et al. J Hematol Oncol. 2016;9(1):109. RAUL CORDOBA, MD, 18
16 Is there any difference in overexpresion of PD-L1 in elderly DLBCL patients? 9p24.1 Normal % 9p24.1 Gain % 9p24.1 High Gain % P- value Age < > COO GCB ABC/non-GCB Unclassified 13 2 Missing 18 2 No differences in 9p24.1 gain among younger vs older patients 9p24.1 gain was associated with ABC subtype Wang Y et al. ASH 2017 RAUL CORDOBA, MD, 19
17 Agenda Aging and lymphoma Immunosenescence and antitumoral immune response Evasion mechanisms of immune response in lymphoma Tailoring therapy in older patients with lymphoma Efficacy and safety of immunotherapy in older patients with lymphoma RAUL CORDOBA, MD, 17
18 Treatment algorithm for aggressive B-cell NHL n=200 n=100 n=50 n=50 n=25 n=25 n=25 n=50 n=10 n=15 3rd line line salvage n=90 Adapted from: Friedberg JW. Hematology Am Soc Hematol Educ Program RAUL CORDOBA, MD, 21
19 Practical Assessment in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology Assessment Predict chemotherapy toxicity Estimate (noncancer) life expectancy Functional assessment Comorbidity assessment Screening for falls Screening for depression Screening for cognitive impairment Screening for malnutrition Tool CARG, CRASH eprognosis IADL CIRS-G, CCI How many falls have you had in the previous 6 months (or since your last visit)? GDS Mini-COG weight loss/body mass index Mohile SG et al. J Clin Oncol 2018; May 21:JCO RAUL CORDOBA, MD, 22
20 SIOG guidelines on DLBCL in the elderly: Impact of prognosis, comorbidities, geriatric assessment 1 and approach to therapy 2 Comorbidity Cardiovascular Renal dysfunction Neuropathy Diabetes Pre-existent marrow compromise (prior chemotherapy, radiation) Dementia Treatment agents Anthracyclines Platinum derivates Platinum derivatives, vinca alkaloids, lenalidomide Prednisone Any myelosuppressive agents All therapies Therapy n Median age, years (range) Efficacy, CR rate RCHOP CHOP P value CHOP vs RCHOP (60 80) 76% 63% CHOP vs RCHOP (60 80) 78% 68% CHOP vs RCHOP (60 80) 77% 76% NS RCHOP21 RCHOP14 RCHOP21 vs RCHOP (60 80) 74% 71% NS RCHOP21 vs RCHOP (19 88) 63% 58% NS 1. Morrison VA et al. J Geriatr Oncol. 2015;6(2): Morrison VA et al. Ann Oncol. 2015;26(6): RAUL CORDOBA, MD, 23
21 DLBCL patients who may benefit from a curative treatment Patient characteristics N % Total number of evaluable patients 252 Male Age, years; median (range) 83 (80-100) Older than ECOG R-IPI Intermediate risk (1-2) High risk (3-5) Patient characteristics N % CIRS< First line treatment R-CHOP Others Rituximab in 1st or subsequent lines Anthracyclines in 1st or subsequent lines Pardal E et al. Am J Hematol Apr 15 RAUL CORDOBA, MD, 24
22 DLBCL patients who may benefit from a curative treatment Multivariate analysis for survival restricted to patients treated with R-CHOP at full or reduced doses Overall survival of patients treated with R- CHOP at full or reduced doses according to prognostic factors Prognostic factor PFS P OS P RR (IC 95%) RR (IC 95%) Age 0,137 0,53 (0,28-0,99) 0,049 < 86 years 86 years CIRS score 0,53 (0,33-0,83) 0,01 0,52 (0,31-0,86) 0,01 < 6 6 R-IPI 0,59 (0,36-0,95) 0,032 0,57 (0,34-0,96) 0,033 Int risk (1-2) High risk (3-5) Score months Score months P = Pardal E et al. Am J Hematol Apr 15 RAUL CORDOBA, MD, 25
23 CGA to support treatment decisions in older patients with lymphoma Tucci A et al. Leuk Lymphoma 2015; 56(4): RAUL CORDOBA, MD, 26
24 OS of fit (a), unfit (b) and frail (c) older patients with DLBCL fit unfit frail Tucci A et al. Leuk Lymphoma 2015; 56(4): RAUL CORDOBA, MD, 27
25 Treatment algorithm for aggressive B-cell NHL n=200 n=100 n=50 n=50 n=25 n=25 n=25 n=50 n=10 n=15 3rd line line salvage n=90 Adapted from: Friedberg JW. Hematology Am Soc Hematol Educ Program RAUL CORDOBA, MD, 28
26 Autologous Stem Cell Transplantation in Elderly Lymphoma Patients Sun L et al. Oncologist. 2018;23(5): RAUL CORDOBA, MD, 29
27 Agenda Aging and lymphoma Immunosenescence and antitumoral immune response Evasion mechanisms of immune response in lymphoma Tailoring therapy in older patients with lymphoma Efficacy and safety of immunotherapy in older patients with lymphoma RAUL CORDOBA, MD, 27
28 PD-1 blockade in HL Lymphoma Antibody, dose Phase; No. of patients R/R chl Nivolumab, 3 mg/kg every 2 weeks R/R chl that progressed after BV R/R chl that failed to respond to ASCT and BV R/R chl, progressed after ASCT and/or BV Pembrolizumab, 10 mg/kg q2w Nivolumab, 3 mg/kg every 2 weeks Pembrolizumab, 200 mg once every 3 weeks, (median No. of treatment cycles: 13) Phase I; n=23 Phase Ib; n=32 Phase II; n=80 Phase II; n=210 ORR, CR PFS; OS; duration of response 87%, 17% PFS: 86% at 24 weeks; OS: 91% at 1 year and 83% at 1.5 years; 35% of responders, sustained maintained response 65%, 16% PFS: 46% at 52 weeks; 70% of responses lasted longer than 24 weeks 68%, 13% At 6 months, PFS: 76.9%; OS: 98.7%; at 12 months, median PFS: 10.0 months 69%, 22.4% At 6 months, PFS: 72.4%; OS: 99.5%; 75.6% of patients had a response for 6 months Rates of all AEs, grade 3-4 AEs Age, years, median (range) Older adults (>65 y.o.) 78%, 22% 35 (20-54) N=0, 0% 97%, 16% 32 (20-67) N=1, 3% 99%, 41% 39 (18 72) N=3, 4% 63%; iraes: 28.6%; IRR: 6.4%. All patients: 35 (18-76) Cohort 1 (after ASCT/BV): 34 (19-64) Cohort 2 (ASCT ineligible and BV failure): 40 (20-76) Cohort 3 (no BV after ASCT): 32 (18-73) All patients: n=18, 8.6% Cohort 2: n=15, 18.5% Cohort 3: n=3, 5.0% Cordoba R. ASCO Educational Book 31
29 PD-1 blockade in NHL Lymphoma Antibody, dose Phase; No. of patients R/R NHL and MM R/R PMBCL R/R CLL with RT and relapsed CLL R/R PCNSL and PTL Nivolumab, 1-3 mg/kg every 2 weeks Pembrolizumab, 10 mg/kg q2w or 200 mg q3w for up to 2 years Pembrolizumab, 200 mg every 3 weeks for up to 2 years Nivolumab, 3 mg/kg iv q2w Phase Ib; FL: n=10, DLBCL: n=11, other B-NHL: n=10, TNHL:n=23, MM: n=27 Phase Ib; n=18 Phase II; n=25 (transformed DLBCL: n=9, Relapsed CLL: n=16) R/R PCNSL: n=4, PTL with CNS relapse: n=1. ORR, CR FL: 40%,10%; DLBCL: 36%, 18%; other B-NHL: 0%, 0%; T-NHL: 17%, 0%; MM: 4%, 4% PFS; OS; duration of response Duration of response: weeks. 41%, 11.8% Median duration of response and OS were not reached RT (transformed DLBCL): 44%, 11%; Relapsed CLL: 0%, 0% Median OS: 10.7 months for R/R CLL with RT, not reached among patients with prior ibrutinib therapy. 100%, 80% 3 patients remained free of progression at 13+ to 17+ months. Rates of all AEs, grade 3-4 AEs All AEs: 63%; (for B-NHL: 71%, 26%) Age, years, median (range) B-Cell Lymphoma 65 (23-74) T-cell lymphoma 61 (30-81) Older adults (>65 y.o.) 61%, 11.8% 30 (22-62) N=0; 0% 100%, 60% Total 69 (46-81) RT 69 (46-78) CLL 72 (59-81) Included, but no % reported Total* 4 (44%) RT* 9 (56%) CLL* 13 (52%) *>70 y.o. 60%, 20% 64 years (54-85) N=3, 60% Cordoba R. ASCO Educational Book 32
30 Take home messages The increasing median age at diagnosis of NHL urges to deliver special health care to older patients CGA will allow to identify older patients who are candidates to receive a curative therapy, not only at diagnosis but also at first relapse Immunosenescence may play a role in lymphomagenesis and it should be explored before an immunotherapy approach: towards an Immune Comprehensive Assessment There are very limited data about the efficacy and safety of immunotherapy in older patients with lymphoma, though it seems feasible CAR T cells would be a treatment strategy feasible for older patients with R/R B-cell NHL RAUL CORDOBA, MD, 39
What are the hurdles to using cell of origin in classification to treat DLBCL?
What are the hurdles to using cell of origin in classification to treat DLBCL? John P. Leonard, M.D. Richard T. Silver Distinguished Professor of Hematology and Medical Oncology Associate Dean for Clinical
More informationImmune checkpoint inhibitors in lymphoma. Catherine Hildyard Haematology Senior Registrar Oxford University Hospitals NHS Foundation Trust
Immune checkpoint inhibitors in lymphoma Catherine Hildyard Haematology Senior Registrar Oxford University Hospitals NHS Foundation Trust Aims How immune checkpoint inhibitors work Success of immune checkpoint
More informationAggressive lymphomas ASH Dr. A. Van Hoof A.Z. St.Jan, Brugge-Oostende AV
Aggressive lymphomas ASH 2015 Dr. A. Van Hoof A.Z. St.Jan, Brugge-Oostende AV CHOP 1992 2002 R-CHOP For DLBCL High dose chemo With PBSCT Aggressive lymphomas 1.DLBCL 2.Primary Mediastinal Lymphoma 3.CNS
More informationOSCO/OU ASH-SABC Review. Lymphoma Update. Mohamad Cherry, MD
OSCO/OU ASH-SABC Review Lymphoma Update Mohamad Cherry, MD Outline Diffuse Large B Cell Lymphoma Double Hit Lymphoma Follicular and Indolent B Cell Lymphomas Mantle Cell Lymphoma T Cell Lymphoma Hodgkin
More informationDiffuse Large B-Cell Lymphoma (DLBCL)
Diffuse Large B-Cell Lymphoma (DLBCL) DLBCL/MCL Dr. Anthea Peters, MD, FRCPC University of Alberta/Cross Cancer Institute Disclosures Honoraria from Janssen, Abbvie, Roche, Lundbeck, Seattle Genetics Objectives
More informationHaemato-Oncology ESMO PRECEPTORSHIP PROGRAMME IMMUNO-ONCOLOGY. Development and clinical experience Monique Minnema, hematologist
Haemato-Oncology ESMO PRECEPTORSHIP PROGRAMME IMMUNO-ONCOLOGY Development and clinical experience Monique Minnema, hematologist Consultancy for disclosures Amgen, Celgene, Jansen Cilag, BMS, Takeda Immune
More informationRichter s Syndrome: Risk, Predictors and Treatment
Richter s Syndrome: Risk, Predictors and Treatment 10/23/2015 John N. Allan MD Assistant Professor of Medicine Division of Hematology and Medical Oncology CLL Research Center Weill Cornell Medicine Agenda
More informationLinfoma de Hodgkin. Novos medicamentos. Otavio Baiocchi CRM-SP
Linfoma de Hodgkin Novos medicamentos Otavio Baiocchi CRM-SP 96.074 Hodgkin Lymphoma Unique B-cell lymphoma HRS malignant cells Scattered malignant Hodgkin-Reed-Sternberg (RS) cells in a background of
More informationCheckpoint Blockade in Hematology and Stem Cell Transplantation
Checkpoint Blockade in Hematology and Stem Cell Transplantation Saad S. Kenderian, MD Assistant Professor of Medicine and Oncology Mayo Clinic College of Medicine October 14, 2016 2015 MFMER slide-1 Disclosures
More informationCheckpoint Inhibition in Hodgkin s Lymphoma John Kuruvilla, MD & Rob Laister, PhD
Checkpoint Inhibition in Hodgkin s Lymphoma John Kuruvilla, MD & Rob Laister, PhD Disclosures for Rob Laister Research Support Employee Consultant Major Stockholder Speakers Bureau Honoraria Scientific
More informationState of the Art Treatment for Relapsed Mantle Cell Lymphoma
Winship Cancer Institute of Emory University State of the Art Treatment for Relapsed Mantle Cell Lymphoma Jonathon B. Cohen, MD, MS Assistant Professor, BMT Program Emory University- Winship Cancer Institute
More informationManagement of high-risk diffuse large B cell lymphoma: case presentation
Management of high-risk diffuse large B cell lymphoma: case presentation Daniel J. Landsburg, MD Assistant Professor of Clinical Medicine Perelman School of Medicine University of Pennsylvania January
More informationBendamustine, Bortezomib and Rituximab in Patients with Relapsed/Refractory Indolent and Mantle-Cell Non-Hodgkin Lymphoma
Bendamustine, Bortezomib and Rituximab in Patients with Relapsed/Refractory Indolent and Mantle-Cell Non-Hodgkin Lymphoma Friedberg JW et al. Proc ASH 2009;Abstract 924. Introduction > Bendamustine (B)
More informationGenomics in diffuse large B cell lymphoma (DLBCL) not as useful as we thought. OR IS IT?
Genomics in diffuse large B cell lymphoma (DLBCL) not as useful as we thought. OR IS IT? Matt McKinney MD Instructor in Medicine, Division of Hematologic Malignancies, Department of Medicine Duke University
More informationAggressive NHL and Hodgkin Lymphoma. Dr. Carolyn Faught November 10, 2017
Aggressive NHL and Hodgkin Lymphoma Dr. Carolyn Faught November 10, 2017 What does aggressive mean? Shorter duration of symptoms Generally need treatment at time of diagnosis Immediate, few days, few weeks
More informationR/R DLBCL Treatment Landscape
An Updated Analysis of JULIET, a Global Pivotal Phase 2 Trial of Tisagenlecleucel in Adult Patients With Relapsed or Refractory Diffuse Large B-Cell Lymphoma Abstract S799 Borchmann P, Tam CS, Jäger U,
More informationAggressive B-cell lymphomas and gene expression profiling towards individualized therapy?
Aggressive B-cell lymphomas and gene expression profiling towards individualized therapy? Andreas Rosenwald Institute of Pathology, University of Würzburg, Germany Barcelona, June 18, 2010 NEW WHO CLASSIFICATION
More informationUpdate: Non-Hodgkin s Lymphoma
2008 Update: Non-Hodgkin s Lymphoma ICML 2008: Update on non-hodgkin s lymphoma Diffuse Large B-cell Lymphoma Improved outcome of elderly patients with poor-prognosis diffuse large B-cell lymphoma (DLBCL)
More informationMariano Provencio Servicio de Oncología Médica Hospital Universitario Puerta de Hierro. Immune checkpoint inhibition in DLBCL
Mariano Provencio Servicio de Oncología Médica Hospital Universitario Puerta de Hierro Immune checkpoint inhibition in DLBCL Immunotherapy: The Cure is Inside Us Our immune system prevents or limit infections
More informationMantle Cell Lymphoma New scenario and concepts in front-line treatment for young pa:ents
Mantle Cell Lymphoma New scenario and concepts in front-line treatment for young pa:ents Anas Younes, M.D. Chief, Lymphoma Service Memorial Sloan-Ke=ering Cancer Center Friday March 16, 2018: 11:15-11:30
More informationHodgkin Lymphoma New Combo-Steps
New Drugs In Hematology Hodgkin Lymphoma New Combo-Steps Anas Younes, M.D. Chief, Lymphoma Service Memorial Sloan-Kettering Cancer Center Monday, May 9, 2016 2:55-3:10 p.m Combinations with Immune Checkpoint
More informationDefined lymphoma entities in the current WHO classification
Defined lymphoma entities in the current WHO classification Luca Mazzucchelli Istituto cantonale di patologia, Locarno Bellinzona, January 29-31, 2016 Evolution of lymphoma classification Rappaport Lukes
More information2018 KSMO Immune Oncology Forum. Immune checkpoint inhibitors in hematologic. malignancies: evidences and perspectives 서울아산병원종양내과 홍정용
2018 KSMO Immune Oncology Forum Immune checkpoint inhibitors in hematologic malignancies: evidences and perspectives 서울아산병원종양내과 홍정용 2018-07-18 Contents Introduction Immune checkpoint inhibtors in lymphomas
More informationCAR-T cell therapy pros and cons
CAR-T cell therapy pros and cons Stephen J. Schuster, MD Professor of Medicine Perelman School of Medicine of the University of Pennsylvania Director, Lymphoma Program & Lymphoma Translational Research
More informationPembrolizumab in Relapsed/Refractory Classical Hodgkin Lymphoma: Phase 2 KEYNOTE-087 Study
Pembrolizumab in Relapsed/Refractory Classical Hodgkin Lymphoma: Phase 2 KEYNOTE-087 Study Craig H. Moskowitz, 1 Pier Luigi Zinzani, 2 Michelle A. Fanale, 3 Philippe Armand, 4 Nathalie Johnson, 5 John
More informationNew Evidence reports on presentations given at EHA/ICML Bendamustine in the Treatment of Lymphoproliferative Disorders
New Evidence reports on presentations given at EHA/ICML 2011 Bendamustine in the Treatment of Lymphoproliferative Disorders Report on EHA/ICML 2011 presentations Efficacy and safety of bendamustine plus
More informationNON HODGKINS LYMPHOMA: AGGRESSIVE Updated June 2015 by Dr. Manna (PGY-5 Medical Oncology Resident, University of Calgary)
NON HODGKINS LYMPHOMA: AGGRESSIVE Updated June 2015 by Dr. Manna (PGY-5 Medical Oncology Resident, University of Calgary) Reviewed by Dr. Michelle Geddes (Staff Hematologist, University of Calgary) and
More informationIs there a role of HDT ASCT as consolidation therapy for first relapse follicular lymphoma in the post Rituximab era? Yes
Is there a role of HDT ASCT as consolidation therapy for first relapse follicular lymphoma in the post Rituximab era? Yes Bertrand Coiffier Service d Hématologie Hospices Civils de Lyon Equipe «Pathologie
More informationUse of Single-Arm Cohorts/Trials to Demonstrate Clinical Benefit for Breakthrough Therapies. Eric H. Rubin, MD Merck Research Laboratories
Use of Single-Arm Cohorts/Trials to Demonstrate Clinical Benefit for Breakthrough Therapies Eric H. Rubin, MD Merck Research Laboratories Outline Pembrolizumab P001 study - example of multiple expansion
More informationPD-1/PD-L1 inhibitors in hematological malignancies, with focus on Lymphoid Malignancies
PD-1/PD-L1 inhibitors in hematological malignancies, with focus on Lymphoid Malignancies Professor Lim Soon Thye Head, Division of Medical Oncology National Cancer Centre Singapore Head, Singhealth Duke-NUS
More informationCARE at ASH 2014 Lymphoma. Dr. Diego Villa Medical Oncologist British Columbia Cancer Agency Vancouver Cancer Centre
CARE at ASH 2014 Lymphoma Dr. Diego Villa Medical Oncologist British Columbia Cancer Agency Vancouver Cancer Centre High-yield lymphoma sessions Sat, Dec 6 th Sun, Dec 7 th Mon, Dec 8 th EDUCATIONAL SESSIONS
More informationLymphoma- Med A-new drugs and treatments
Lymphoma- Med A-new drugs and treatments Silvia Montoto Lisbon, 19/03/2018 #EBMT18 www.ebmt.or Disclosures: Roche, Gilead Silvia Montoto Lisbon, 19/03/2018 #EBMT18 www.ebmt.or Outline Lymphoma- what is
More informationRelapsed/Refractory Hodgkin Lymphoma
Relapsed/Refractory Hodgkin Lymphoma Anas Younes, MD Chief, Lymphoma Service Memorial Sloan-Kettering Cancer Center New York, New York, United States Case Study 32-year-old woman was diagnosed with stage
More informationAggressive B and T cell lymphomas: Treatment paradigms in 2018
Aggressive B and T cell lymphomas: Treatment paradigms in 2018 John P. Leonard M.D. Richard T. Silver Distinguished Professor of Hematology and Medical Oncology Associate Dean for Clinical Research Associate
More informationMantle cell lymphoma An update on management
Mantle cell lymphoma An update on management Dr Kim Linton Consultant Medical Oncologist The Christie NHS Foundation Trust 6 th October 2016 This educational meeting is organised and sponsored by Janssen-Cilag
More informationTHE ROLE OF TARGETED THERAPY AND IMMUNOTHERAPY IN THE TREATMENT OF ADVANCED CERVIX CANCER
Gynecologic Cancer InterGroup Cervix Cancer Research Network THE ROLE OF TARGETED THERAPY AND IMMUNOTHERAPY IN THE TREATMENT OF ADVANCED CERVIX CANCER Linda Mileshkin, Medical Oncologist Peter MacCallum
More informationRadiotherapy in DLCL is often worthwhile. Dr. Joachim Yahalom Memorial Sloan-Kettering, New York
Radiotherapy in DLCL is often worthwhile Dr. Joachim Yahalom Memorial Sloan-Kettering, New York The case for radiotherapy Past: Pre-Rituximab randomized trials Present: R-CHOP as backbone, retrospective
More informationFOLLICULAR LYMPHOMA: US vs. Europe: different approach on first relapse setting?
Indolent Lymphoma Workshop Bologna, Royal Hotel Carlton May 2017 FOLLICULAR LYMPHOMA: US vs. Europe: different approach on first relapse setting? Armando López-Guillermo Department of Hematology, Hospital
More informationTreatment of elderly multiple myeloma patients
SAMO Interdisciplinary Workshop on Myeloma March 30 th -31 st 2012, Seehotel Hermitage, Lucerne Treatment of elderly multiple myeloma patients Federica Cavallo, MD, PhD Federica Cavallo, MD, PhD Division
More informationTreatment Landscape in R/R DLBCL Novel Targets and Strategies. Wyndham H. Wilson, M.D., Ph.D. Senior Investigator
Treatment Landscape in R/R DLBCL Novel Targets and Strategies Wyndham H. Wilson, M.D., Ph.D. Senior Investigator Gene-expression profiling of DLBCL subtypes Roschewski, M. et al. (2013) Nat. Rev. Clin.
More informationBackground. Outcomes in refractory large B-cell lymphoma with traditional standard of care are extremely poor 1
2-Year Follow-Up and High-Risk Subset Analysis of ZUMA-1, the Pivotal Study of Axicabtagene Ciloleucel (Axi-Cel) in Patients with Refractory Large B Cell Lymphoma Abstract 2967 Neelapu SS, Ghobadi A, Jacobson
More informationSEQUENCING FOLLICULAR LYMPHOMA
SEQUENCING FOLLICULAR LYMPHOMA Thomas E. Witzig, MD October 24, 2015 Disclosures All presenters were independently selected by the organizing committee. Those presenters who disclosed affiliations or financial
More informationThe treatment of DLBCL. Michele Ghielmini Medical Oncology Dept Oncology Institute of Southern Switzerland Bellinzona
The treatment of DLBCL Michele Ghielmini Medical Oncology Dept Oncology Institute of Southern Switzerland Bellinzona NHL frequency at the IOSI Mantle Cell Lymphoma 6.5 % Diffuse Large B-cell Lymphoma 37%
More informationThe case against maintenance rituximab in Follicular lymphoma. Jonathan W. Friedberg M.D., M.M.Sc.
The case against maintenance rituximab in Follicular lymphoma Jonathan W. Friedberg M.D., M.M.Sc. Follicular lymphoma: What are goals of treatment? Change natural history of disease: Decrease transformation
More informationESMO DOUBLE-HIT LYMPHOMAS
ESMO DOUBLE-HIT LYMPHOMAS Professor Dr. med. Georg Lenz Director Department of Hematology and Oncology Universitätsklinikum Münster, Germany OVERVIEW Definition of double-hit lymphomas Introduction in
More informationFollicular Lymphoma 2016:
Follicular Lymphoma 2016: Evolving Management Strategies Randeep Sangha, MD Medical Oncology, Cross Cancer Institute Associate Professor, University of Alberta Edmonton, AB Disclosures I have no actual
More informationPrevalent lymphomas in Africa
Prevalent lymphomas in Africa Dr Zainab Mohamed Clinical Oncologist GSH/UCT Groote Schuur Hospital Disclaimer I declare that I have no conflict of interest Groote Schuur Hospital Denis Burkitt 1911-1993
More informationA CME-certified Oncology Exchange Program
A CME-certified Oncology Exchange Program Jointly provided by Potomac Center for Medical Education and Rockpointe Supported by an educational grant from Seattle Genetics, Inc. Re-treatment with BV Bartlett
More informationMMAE disrupts cell division and triggers apoptosis. Pola binds to cell surface antigen CD79b. Pola is internalized; linker cleaves, releasing MMAE
Adding Polatuzumab Vedotin (Pola) to Bendamustine and Rituximab () Treatment Improves Survival in Patients With Relapsed/Refractory DLBCL: Results of a Phase II Clinical Trial Abstract S802 Sehn LH, Kamdar
More informationDr. A. Van Hoof Hematology A.Z. St.Jan, Brugge. ASH 2012 Atlanta
Dr. A. Van Hoof Hematology A.Z. St.Jan, Brugge ASH 2012 Atlanta DLBCL How to improve on R-CHOP What at relapse Mantle cell lymphoma Do we cure patients Treatment at relapse Follicular lymphoma Watch and
More informationThe case for maintenance rituximab in FL
New-York, October 23 rd 2015 The case for maintenance rituximab in FL Pr. Gilles SALLES For FL patients, progression-free survival still needs to be improved Median R-CHVP-I 66 months P
More informationDiffuse Large B-Cell Lymphoma Front line Therapy John P. Leonard, MD Weill Cornell Medicine New York, New York USA
Diffuse Large B-Cell Lymphoma Front line Therapy John P. Leonard, MD Weill Cornell Medicine New York, New York USA Disclosures Consulting advice: Hospira, Bayer, Juno Therapeutics, Teva, Oncotracker, Gilead
More informationHighlights of ICML 2015
Highlights of ICML 2015 Jonathan W. Friedberg M.D. Director, James P. Wilmot Cancer Center Statistics, ICML 2015: a global meeting Almost 3700 participants. 90 countries represented. Attendees: USA 465
More informationRisk stratification in the older patient; what are our priorities?
Risk stratification in the older patient; what are our priorities? Sonja Zweegman MD PhD Amsterdam The Netherlands Negative impact of age on survival Meta-analysis of European trials (MP vs MPT, VMP vs
More informationNew Agents Beyond Brentuximab vedotin for Hodgkin Lymphoma. Stephen M. Ansell, MD, PhD Professor of Medicine Mayo Clinic
New Agents Beyond Brentuximab vedotin for Hodgkin Lymphoma Stephen M. Ansell, MD, PhD Professor of Medicine Mayo Clinic Disclosures for Stephen Ansell, MD, PhD In compliance with ACCME policy, Mayo Clinic
More informationBendamustine is Effective Therapy in Patients with Rituximab-Refractory, Indolent B-Cell Non-Hodgkin Lymphoma
Bendamustine is Effective Therapy in Patients with Rituximab-Refractory, Indolent B-Cell Non-Hodgkin Lymphoma Kahl BS et al. Cancer 2010;116(1):106-14. Introduction > Bendamustine is a novel alkylating
More informationMantle cell lymphoma Allo stem cell transplantation in relapsed and refractory patients
Mantle cell lymphoma Allo stem cell transplantation in relapsed and refractory patients Olivier Hermine MD, PhD Department of Hematology INSERM and CNRS, Imagine Institute Necker Hospital Paris, France
More informationROB LOWN SOUTHAMPTON HODGKIN LYMPHOMA IN THE ELDERLY
ROB LOWN SOUTHAMPTON HODGKIN LYMPHOMA IN THE ELDERLY EPIDEMIOLOGY HODGKIN LYMPHOMA - INCIDENCE EPIDEMIOLOGY HODGKIN LYMPHOMA - MORTALITY EPIDEMIOLOGY HODGKIN LYMPHOMA - MORTALITY BY AGE NUMBER OF PEOPLE
More informationImmune checkpoint inhibitors in Hodgkin and non-hodgkin Lymphoma: How do they work? Where will we use them? Stephen M. Ansell, MD, PhD Mayo Clinic
Immune checkpoint inhibitors in Hodgkin and non-hodgkin Lymphoma: How do they work? Where will we use them? Stephen M. Ansell, MD, PhD Mayo Clinic Conflicts of Interest Research Funding from Bristol Myers
More informationOutcome of DLBCL patients over 80 years: A retrospective survey from 4 Institutions
Outcome of DLBCL patients over 80 years: A retrospective survey from 4 Institutions AA Moccia, S Gobba, A Conconi, S Diem, L Cascione, K Aprile von Hohenstaufen, W Gulden Sala, A Stathis, F Hitz, G Pinotti,
More informationIMMUNOTHERAPY FOR GASTROINTESTINAL CANCERS
IMMUNOTHERAPY FOR GASTROINTESTINAL CANCERS Dr Elizabeth Smyth Cambridge University Hospitals NHS Foundation Trust ESMO Gastric Cancer Preceptorship Valencia 2018 DISCLOSURES Honoraria for advisory role
More informationLymphoma Christophe BONNET Centre Hospitalier Universitaire, Ulg, Liège. 14 th post-ash meeting, January 6 th 2011, Brussels
Lymphoma Christophe BONNET Centre Hospitalier Universitaire, Ulg, Liège 14 th post-ash meeting, January 6 th 2011, Brussels Hodgkin s lymphoma Follicular lymphoma Diffuse large B-cell lymphoma Mantle cell
More informationHave we moved beyond EPOCH for B-cell non-hodgkin lymphoma? YES!
Have we moved beyond EPOCH for B-cell non-hodgkin lymphoma? YES! Christopher Flowers, MD, MSc Associate Professor Director, Lymphoma Program Department of Hematology and Oncology Emory School of Medicine
More informationDouble hit lymphoma Clinical perspectives
Double hit lymphoma Clinical perspectives Peter Johnson Some definitions, for clarity Double-hit lymphoma (5% of DLBL) Rearranged MYC (8q24) by FISH Plus either rearranged BCL2 (18q21) or BCL6 (3q27) Double-expression
More informationNK/T cell lymphoma Recent advances. Y.L Kwong University Department of Medicine Queen Mary Hospital
NK/T cell lymphoma Recent advances Y.L Kwong University Department of Medicine Queen Mary Hospital Natural killer cell lymphomas NK cell lymphomas are mainly extranodal lymphomas Clinical classification
More informationNew Targets and Treatments for Follicular Lymphoma
Winship Cancer Institute of Emory University New Targets and Treatments for Follicular Lymphoma Jonathon B. Cohen, MD, MS Assistant Professor Div of BMT, Emory University Intro/Outline Follicular lymphoma,
More informationChronic Lymphocytic Leukemia (CLL): Refresher Course for Hematologists Ekarat Rattarittamrong, MD
Chronic Lymphocytic Leukemia (CLL): Refresher Course for Hematologists Ekarat Rattarittamrong, MD Division of Hematology Department of Internal Medicine Faculty of Medicine Chiang-Mai University Outline
More informationHodgkin Lymphoma in Older Patients
Hodgkin Lymphoma in Older Patients Andrew M. Evens, DO, MSc March 26 th, 2015 Professor of Medicine Chief, Division of Hematology/Oncology Director, Tufts Cancer Center Tufts Medical Center Elderly Hodgkin
More informationInduction Therapy & Stem Cell Transplantation for Myeloma
Induction Therapy & Stem Cell Transplantation for Myeloma William Bensinger, MD Professor of Medicine, Division of Oncology University of Washington School of Medicine Director, Autologous Stem Cell Transplant
More informationKamakshi V Rao, PharmD, BCOP, FASHP University of North Carolina Medical Center UPDATE IN REFRACTORY HODGKIN LYMPHOMA
Kamakshi V Rao, PharmD, BCOP, FASHP University of North Carolina Medical Center UPDATE IN REFRACTORY HODGKIN LYMPHOMA Objectives Describe the current standard approach for patients with relapsed/refractory
More informationHow to incorporate new therapies into the treatment algorithm of patients with mantle cell lymphoma
How to incorporate new therapies into the treatment algorithm of patients with mantle cell lymphoma Dr. Guillermo Rodríguez García Hospital Universitario Virgen Macarena Hospital Universitario Virgen del
More informationAggressive B-cell Lymphomas
Neoplastic Hematopathology Update 2018 Aggressive B-cell Lymphomas Raju K. Pillai City of Hope National Medical Center I do not have any disclosures Disclosures Outline New entities and changes in WHO
More informationHistology independent indications in Oncology
CHMP Oncology Working Party Workshop Histology independent indications in Oncology What have we learnt from the anti PD1- PDL1 story? J Camarero (CHMP alternate ES, OncWP) Disclaimers the views presented
More informationCLL: disease specific biology and current treatment. Dr. Nathalie Johnson
CLL: disease specific biology and current treatment Dr. Nathalie Johnson Disclosures Consultant and Advisory boards Roche, Abbvie, Gilead, Jansson, Lundbeck,Merck Research funding Roche, Abbvie, Lundbeck
More informationTREATMENT FOR NON-TRANSPLANT ELIGIBLE MULTIPLE MYELOMA
TREATMENT FOR NON-TRANSPLANT ELIGIBLE MULTIPLE MYELOMA Ekarat Rattarittamrong, MD Division of Hematology Department of Internal Medicine Faculty of Medicine Chiang Mai University OUTLINE Overview of treatment
More informationNON HODGKINS LYMPHOMA: INDOLENT Updated June 2015 by Dr. Manna (PGY-5 Medical Oncology Resident, University of Calgary)
NON HODGKINS LYMPHOMA: INDOLENT Updated June 2015 by Dr. Manna (PGY-5 Medical Oncology Resident, University of Calgary) Reviewed by Dr. Michelle Geddes (Staff Hematologist, University of Calgary) and Dr.
More informationPatterns of Care in Medical Oncology. Follicular Lymphoma
Patterns of Care in Medical Oncology Follicular Lymphoma CASE 1: A 72-year-old man with multiple comorbidities including COPD/asthma presents with slowly progressive cervical adenopathy. Bone marrow biopsy
More informationMultiple Myeloma Updates 2007
Multiple Myeloma Updates 2007 Brian Berryman, M.D. Multiple Myeloma Updates 2007 Goals for today: Understand the staging systems for myeloma Understand prognostic factors in myeloma Review updates from
More informationConflict of Interest Disclosure Form NAME :James O. Armitage, M.D AFFILIATION: University of Nebraska Medical Center
What Is Personalized Medicine For Patients With Lymphoma? Conflict of Interest Disclosure Form NAME :James O. Armitage, M.D AFFILIATION: University of Nebraska Medical Center DISCLOSURE I have no potential
More informationState of the art: CAR-T cell therapy in lymphoma
State of the art: CAR-T cell therapy in lymphoma 14 th annual California Cancer Consortium conference Tanya Siddiqi, MD City of Hope Medical Center 8/11/18 Financial disclosures Consultant for Juno therapeutics
More informationAggressive B-cell Lymphomas Updated WHO classification Elias Campo
Aggressive B-cell Lymphomas Updated WHO classification Elias Campo Hospital Clinic, University of Barcelona Diffuse Large B-cell Lymphoma A Heterogeneous Category Subtypes with differing: Histology and
More informationChoice of upfront treatment in the management of diffuse large B-cell lymphoma and follicular lymphoma
Choice of upfront treatment in the management of diffuse large B-cell lymphoma and follicular lymphoma Ryan Lynch MD Assistant Professor, University of Washington Assistant Member, Fred Hutchinson Cancer
More informationHigh grade B-cell lymphomas (HGBL): Altered terminology in the 2016 WHO Classification (Update of the 4 th Edition) and practical issues Xiao-Qiu Li,
High grade B-cell lymphomas (HGBL): Altered terminology in the 2016 WHO Classification (Update of the 4 th Edition) and practical issues Xiao-Qiu Li, M.D., Ph.D. Fudan University Shanghai Cancer Center
More informationToday, how many PTCL patients are cured? Steven M. Horwitz M.D. Associate Attending Lymphoma Service Memorial Sloan Kettering Cancer Center
Today, how many PTCL patients are cured? Steven M. Horwitz M.D. Associate Attending Lymphoma Service Memorial Sloan Kettering Cancer Center Today, how many PTCL patients are cured? Some but not as many
More informationTreatment Nodal Marginal Zone Lymphoma
Workshop : Indolent lymphomas Treatment Nodal Marginal Zone Lymphoma Catherine Thieblemont Hôpital Saint-Louis, Paris - France Bologna 16th, 2017 Ø No standardized treatment Ø Similarly treated as FL Treatment
More informationChanging the landscape of treatment in Peripheral T-cell Lymphoma
Changing the landscape of treatment in Peripheral T-cell Lymphoma Luis Fayad Associate Professor MD Anderson Cancer Center Department of Lymphoma and Myeloma 1 6 What is peripheral 2008 WHO CLASSIFICATION
More informationTransformed follicular lymphoma. Jonathan W. Friedberg M.D., M.M.Sc.
Transformed follicular lymphoma Jonathan W. Friedberg M.D., M.M.Sc. The past: Incidence and Outcome of Transformed NHL Steady risk of 3% per year for first 15 years of diagnosis Treatment (or lack thereof)
More informationPrognostic Factors for PTCL. Julie M. Vose, M.D., M.B.A. University of Nebraska Medical Center
Prognostic Factors for PTCL Julie M. Vose, M.D., M.B.A. University of Nebraska Medical Center jmvose@unmc.edu Distribution of 1314 Cases by Consensus Diagnosis International T-Cell Lymphoma Project Vose
More informationLYMPHOMA in HIV PATIENTS. Silvia Montoto, St Bartholomew s Hospital, London, UK ESMO Preceptorship on Lymphoma
LYMPHOMA in HIV PATIENTS Silvia Montoto, St Bartholomew s Hospital, London, UK ESMO Preceptorship on Lymphoma Lugano, 3-4 November 2017 Disclosures: Roche: honoraria Gilead: travel grant ESMO Preceptorship
More informationTargeted Radioimmunotherapy for Lymphoma
Targeted Radioimmunotherapy for Lymphoma John Pagel, MD, PhD Fred Hutchinson Cancer Center Erik Mittra, MD, PhD Stanford Medical Center Brought to you by: Financial Disclosures Disclosures Erik Mittra,
More informationClinical Advances in Lymphoma
Conflicts of Interest Clinical Advances in Lymphoma Alex F. Herrera, MD Assistant t Professor Department of Hematology and HCT City of Hope BMS research funding (institutional), consultancy Genentech research
More informationDevelopment of Mogamulizumab, a defucosylated anti-ccr4 humanized monoclonal antibody
New Drugs in Hematology Development of Mogamulizumab, a defucosylated anti-ccr4 humanized monoclonal antibody Michinori Ogura, MD, PhD Department of Hematology Tokai Central Hospital Bologna, Royal Hotel
More informationSimposio COSA È CAMBIATO NELL APPROCCIO TERAPEUTICO DEI LINFOMI NON HODGKIN DEL PAZIENTE ANZIANO?
58 Congresso Nazionale Società Italiana di Gerontologia e Geriatria Torino 27-30 novembre 2013 Simposio COSA È CAMBIATO NELL APPROCCIO TERAPEUTICO DEI LINFOMI NON HODGKIN DEL PAZIENTE ANZIANO? C è un ruolo
More informationANCO: ASCO Highlights 2018 Hematologic Malignancies
ANCO: ASCO Highlights 2018 Hematologic Malignancies Brian A. Jonas, M.D., Ph.D. UC Davis Comprehensive Cancer Center August 25, 2018 Brian Jonas, MD, PhD ANCO: ASCO Highlights 2018 Relevant financial relationships
More informationUPDATE Autologous Stem Cell Transplantation for Lymphoma and Myeloma
UPDATE Autologous Stem Cell Transplantation for Lymphoma and Myeloma Supported by a grant from Supported by a grant from UPDATE Autologous Stem Cell Transplantation for Lymphoma and Myeloma Jonathan W.
More informationSupplementary Appendix to manuscript submitted by Trappe, R.U. et al:
Supplementary Appendix to manuscript submitted by Trappe, R.U. et al: Response to rituximab induction is a predictive marker in B-cell post-transplant lymphoproliferative disorder and allows successful
More informationLymphocyte Predominant Hodgkin s Lymphoma. Case Presentation. How would you treat the patient?
Lymphocyte Predominant Hodgkin s Lymphoma Wei Ai, MD, PhD Assistant Clinical Professor University of California, San Francisco January 2010 Case Presentation 32 yo male, diagnosed with stage IIIA lymphocyte
More informationProblems related to the management of malignant hemopathies in older patients
Problems related to the management of malignant hemopathies in older patients Dr Marie Maerevoet Gent, 25 January 2013 BHS satellite symposium on Elderly Malignant Hemopathies in older patients - 33% of
More informationTREATMENT CONSIDERATIONS IN CLL/SLL AND FL. June 6, 2018
TREATMENT CONSIDERATIONS IN CLL/SLL AND FL June 6, 2018 0 PRESENTATION OVERVIEW IN CLL/SLL AND FL: Discuss key considerations that influence patient outcomes Highlight the importance of patients quality
More informationChimeric Antigen Receptor - CAR T cell therapy. Frederick L. Locke, MD 2/17/2017
Chimeric Antigen Receptor - CAR T cell therapy Frederick L. Locke, MD 2/17/2017 T cells are immune system cells that normally fight infection Each T cell recognizes a specific target T cells multiply and
More information